In the Fight to Make the Pill Over-the-Counter, Teen Girls are Being Used as Pawns

It must be noted, I passionately respect and support a persons choice to use hormonal birth control. This article gave me an opportunity to think critically about the topic of hormonal birth control and teen health. There are many instances in life where the benefits of a choice outweigh the risks, the choice to use hormonal birth control can be one of them. I am in no way attempting to tell anyone to stop using the method of birth control that best suits their needs.

The article focuses on a few strategies to make hormonal birth control (HBC) pills and patches available over-the-counter, aka, sans prescription. Several states, including California and Oregon, have passed legislation allowing pharmacists to prescribe the pill or patch to consumers. However, it is contingent upon the requirement that consumers visit a primary care physician within three years of initial use.

The article goes on to highlight a few caveats to making this type of birth control prescription-free, like how insurance companies would no longer be mandated to cover the cost through the ACA, or how it would restrict sales of OTC birth control to those over the age of 18. And herein lies the rub, to change access to self-administered HBC from prescription-based to over-the-counter, the FDA will need to agree that these methods are not of risk to those under the age of 18. As is the case in Oregon, if you are a minor, you are still required to retain a prescription for the pill or patch from your medical provider, rather than your pharmacist.

Krishna Upadhya, an assistant professor at Johns Hopkins University School of Medicine was quoted in the article as saying, “These pills are safe and effective and we should reduce barriers to using them. And teens should benefit just as adult women do.” While it is hard to argue with this, particularly because teen pregnancy rates in the US have been dropping considerably due to increased usage of birth control, a 36% drop from 2007-2013, to be exact, we should not let that negate the importance of transparency when it comes to discussing side effects.

Upadhya goes on to make the claim that HBC use might actually be safer for teens than adults. She also states that “There is a growing body of evidence that the safety risks are low and benefits are large.” Upadhya is making reference to a literature review she published in the Journal of Adolescent Health. For those of you unfamiliar, a literature review is an overview of academic articles published on a particular topic—it is not original research, but merely a way to find trends in the literature. So, while Upadhya is suggesting that HBC use for teens is “potentially” safer than for adult women, the references for her literature review mainly discuss usage and accessibility of birth control among teens. It is not, however, a review of side effects experienced by teens.

After reading Upadhya’s article, I discovered that her claim is based on the following excerpt:

“The safety of OCs [oral contraceptives] has been established in clinical trials and through decades of use in millions of women worldwide. The majority of contraindications [instance where the drug should not be used] are related to the estrogen component of the pills, which may increase the risk of cardiovascular diseases including venous thromboembolism and arterial vascular disease (myocardial infarction and strokes). The background risk of cardiovascular disease in adolescents is low, and therefore, contraindications are very uncommon among adolescent women.”

Translation: young women are at a lesser risk of experiencing life-threatening side effects because they are typically healthier than older women, ergo, HBC is safe for teen usage. So, let’s go ahead and make hormonal birth control accessible to everyone over-the-counter no matter what their age without further discussion. Um, what?

Now, I am not arguing that women and girls should not be able to access hormonal birth control without having to go through the BS rigmarole of having to make an appointment with your doctor, have a pelvic exam, go to the pharmacy, lather, rinse, repeat. I am also in no way saying that teens should not have access to the birth control method of their choice. I believe we should do everything we can to help teens have healthy, safe, and satisfying sex lives free from unwanted pregnancy. But glossing over the very real problems teen girls can experience while on HBC only serves to validate my concern of the missing discussion around the lack of body literacy and physical/emotional changes that come with the long-term medicating of teen girls. In my opinion, these are real problems we don’t talk much about, so, let’s do that now.

The artificial “regulation” of the menstrual cycle through the use of hormonal birth control in teen girls completely shuts down how their reproductive bodies function. For the first few years after menarche, many girls experience irregular cycles because they are not yet ovulating every month. This is because the reproductive hormones are just beginning to gear up to their natural function—which occurs through ovulation.

When you give a young girl artificial hormones before her body has reached its own regulatory status, you risk turning off her body’s ability to ovulate naturally in the future.

Putting a young girl on HBC who has yet to become familiar with her unique cycles also serves to disconnect her from the natural rhythm of her body and can lead to confusion about what is “normal.”

Hormonal birth control also perpetuates the “standardization” of the female body that defines the menstrual cycle as 28-days long. In fact, a healthy and normal menstrual cycle is on a spectrum and can range from 21 to 35 days in length. But by perpetuating the 28-day cycle myth, many women and girls are led to believe their cycles are abnormal and often turn to HBC to “regulate” their cycles. This can be problematic because HBC isn’t really regulating your cycle, it’s merely suppressing it.

It is also important to note that long-term use of HBC can disguise underlying reproductive health issues like menorrhagia (heavy menstruation), dysmenorrhea (painful menstruation), amenorrhea (absence of menstruation), oligomenorrhea (light or infrequent menstruation) or anovulation (missing ovulation). Using HBC does not “cure” these symptoms, it merely masks** them. And what’s even more problematic with using HBC to “treat” cycle irregularities is that it inevitably delays diagnosis and actual treatment.

What’s even more frightening about giving young girls hormonal birth control is that it literally affects their brain development. In a 2015 study on the long-term effects of the hormonal birth control pill, it was discovered that the use of HBC “was associated with significantly lower cortical thickness measurements in the lateral orbitofrontal cortex and the posterior cingulate cortex.” Translation: the orbitofrontal cortex is the part of the brain that sits just above your eyes and is responsible for rational thought and reasoning as well as the expression of our personalities. So, the thinner this part of the brain is the less able one is to think rationally, to reason logically, or to express one’s complete personality, and HBC use thins this part of the brain.

Let that sink in for a minute.

I could continue to outline the negative side effects of HBC use in teen girls, but I think I’ve made my point. So, to bring it back around to the whole reason I wanted to write this article: using teen girls as pawns in the birth control shell-game by declaring that hormonal birth control is “possibly safer” for teen girls so-let’s-make-it-over-the-counter-accessible-to-everyone is dangerous and completely irresponsible.

Teens do not exist as footnotes in “adult” arguments. They are independent, autonomous beings who deserve to be treated with respect. Teen health is not a temporary hurdle to clear in the push to make hormonal birth control available over-the-counter, it is a point that should be seriously considered in the discussion.

Hormonal birth control can have profoundly negative effects on the physiological, psychological, and emotional development of teen girls, and it’s time we stop ignoring it.

Yes, it is imperative to continue to combat unwanted teen pregnancy. Yes, it is crucial to make all forms of birth control accessible to anyone who wants to use it. And yes, girls under the age of 18 have a right to use hormonal birth control. But using teens as pawns, disregarding the very real health risks associated with long-term use of HBC, and continuing to put The Pill on a pedestal as the holy grail of birth control, in my opinion, is flippant and does every teen girl a massive disservice.

*It is important to note that long-term use of hormonal birth control has also been shown to decrease the risk of ovarian and endometrial cancers.

**There are many women out there who experience debilitating menstrual pain, many of whom utilize the cycle suppressing aspects of hormonal birth control just so they can function. I completely respect and support their choice.

amy sutherland - founder

Hey all! My name is Amy Sutherland (she/her), and I have been passionate about sexual health since before I hit puberty. I've spent most of my adult life working as a writer focusing on health and wellness. More particularly, women’s reproductive health.